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Characteristics and predictors of intensive care unit admission in pediatric blunt abdominal trauma
Steven C Mehl1, Megan E Cunningham1, Christian J Streck2
1Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street #1210, Houston, TX, 77030, USA.
Insights
Severe solid organ injury and traumatic brain injury are key predictors for intensive care unit (ICU) admission in pediatric patients with blunt abdominal trauma (BAT). These findings can help optimize ICU resource use.
Area of Science:
- Pediatric Trauma Surgery
- Critical Care Medicine
- Injury Prognostication
Background:
- Blunt abdominal trauma (BAT) in children often necessitates intensive care unit (ICU) admission due to intra-abdominal injuries (IAI).
- Identifying predictors for ICU admission is crucial for effective resource allocation in pediatric trauma care.
Purpose of the Study:
- To identify key predictors of ICU admission in pediatric patients who have sustained blunt abdominal trauma (BAT).
Main Methods:
- A prospective study involving 2,182 children (<16 years) across 14 Level-One Pediatric Trauma Centers.
- Data collected included vitals, physical exam, labs, imaging, and injury details.
- Multivariable hierarchical logistic regression and tenfold cross-validated area under the receiver operating characteristic curves (cvAUC) were used to identify predictors and assess model performance.
Main Results:
- Of 2,182 children, 21% were admitted to the ICU.
- Univariate analysis showed ICU patients had abnormal shock index, higher injury severity scores (ISS), lower Glasgow coma scores (GCS), traumatic brain injury (TBI), and severe solid organ injury (SOI).
- Multivariable analysis identified severe trauma (ISS > 15), anemia (hematocrit < 30), severe TBI (GCS < 8), cervical spine injury, skull fracture, and severe SOI as predictors of ICU admission. The model achieved a cvAUC of 0.91.
Conclusions:
- Severe solid organ injury and traumatic brain injury, particularly in the context of multisystem trauma, are primary drivers for ICU admission in pediatric BAT patients.
- These findings can inform the development of a prediction rule for use in the trauma bay to optimize ICU resource utilization.
Background:
Pediatric trauma patients sustaining blunt abdominal trauma (BAT) with intra-abdominal injury (IAI) are frequently admitted to the intensive care unit (ICU). This study was performed to identify predictors for ICU admission following BAT.
Methods:
Prospective study of children (< 16 years) who presented to 14 Level-One Pediatric Trauma Centers following BAT over a 1-year period. Patients were categorized as ICU or non-ICU patients. Data collected included vitals, physical exam findings, laboratory results, imaging, and traumatic injuries. A multivariable hierarchical logistic regression model was used to identify predictors of ICU admission. Predictive ability of the model was assessed via tenfold cross-validated area under the receiver operating characteristic curves (cvAUC).
Results:
Included were 2,182 children with 21% (n = 463) admitted to the ICU. On univariate analysis, ICU patients were associated with abnormal age-adjusted shock index, increased injury severity scores (ISS), lower Glasgow coma scores (GCS), traumatic brain injury (TBI), and severe solid organ injury (SOI). With multivariable logistic regression, factors associated with ICU admission were severe trauma (ISS > 15), anemia (hematocrit < 30), severe TBI (GCS < 8), cervical spine injury, skull fracture, and severe solid organ injury. The cvAUC for the multivariable model was 0.91 (95% CI 0.88-0.92).
Conclusion:
Severe solid organ injury and traumatic brain injury, in association with multisystem trauma, appear to drive ICU admission in pediatric patients with BAT. These results may inform the design of a trauma bay prediction rule to assist in optimizing ICU resource utilization after BAT.
Study Design:
Prognosis study.
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